Is there an oral equivalent for Vancomycin (vancomycin hydrochloride)?

From the Guidelines

Yes, there is an oral formulation of vancomycin available, and it is primarily used to treat Clostridioides difficile (C. diff) infections in the gastrointestinal tract, with typical dosing of 125 mg taken four times daily for 10-14 days, as recommended by the 2021 focused update guidelines by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) 1.

Key Points to Consider

• For severe or recurrent infections, higher doses of 250-500 mg four times daily may be prescribed, as seen in the 2019 update of the WSES guidelines for management of Clostridioides difficile infection in surgical patients 1.
• Oral vancomycin works differently from intravenous vancomycin, with poor systemic absorption allowing it to remain in the gut and directly target C. diff bacteria, which is beneficial for treating intestinal infections but means it is not effective for treating systemic infections elsewhere in the body.
• Patients should complete the full course of treatment even if symptoms improve before finishing the medication, and common side effects may include nausea, abdominal pain, and rarely, rash or allergic reactions.

Important Considerations for Treatment

• The choice of treatment may depend on the severity of the infection, with vancomycin being the preferred treatment for fulminant CDI, and fidaxomicin being a valid alternative for patients with CDI, especially those at higher risk for recurrence 1.
• The dosage and duration of treatment may vary depending on the specific clinical presentation and the presence of risk factors for recurrence, as outlined in the 2020 recommendations and guidelines for the treatment of Clostridioides difficile infection in Taiwan 1.
• It is essential to consider the potential for adverse effects, such as metronidazole-related neurotoxicity, and to discontinue unnecessary antibiotics as soon as possible to minimize the risk of recurrence and promote effective treatment outcomes.

From the FDA Drug Label

Vancomycin Hydrochloride Capsules USP for oral administration contain chromatographically purified vancomycin hydrochloride, a tricyclic glycopeptide antibiotic derived from Amycolatopsis orientalis (formerly Nocardia orientalis) 2 The capsules contain 125 mg vancomycin (equivalent to 128 mg vancomycin hydrochloride) 2 The capsules contain 250 mg vancomycin (equivalent to 256 mg vancomycin hydrochloride) 2

Oral Equivalent for Vancomycin:

• Vancomycin is available in oral form as Vancomycin Hydrochloride Capsules USP, which contain 125 mg or 250 mg of vancomycin 2
• The oral form of vancomycin is used to treat C. difficile associated diarrhea and enterocolitis caused by S. aureus (including methicillin-resistant strains) 2
• Key Points:
  • Vancomycin Hydrochloride Capsules USP are available for oral administration
  • The capsules contain either 125 mg or 250 mg of vancomycin
  • Used to treat specific infections, including C. difficile associated diarrhea and enterocolitis caused by S. aureus 2

From the Research

Oral Equivalent for Vancomycin

There are several oral antibiotics that can be considered as alternatives to vancomycin for the treatment of certain infections.

• Linezolid is an oral antibiotic that has been shown to be effective in treating skin and soft tissue infections, including those caused by methicillin-resistant Staphylococcus aureus (MRSA) 3, 4.
• Linezolid has been compared to vancomycin in several studies, and has been found to have similar or better clinical and microbiological cure rates in some cases 3, 4.
• The use of linezolid as an oral equivalent for vancomycin may be beneficial in terms of reducing the length of hospital stay and the duration of intravenous therapy 3, 4.
• However, it is essential to note that linezolid and vancomycin have different mechanisms of action, spectra of activity, and side effect profiles, and therefore may not be interchangeable in all situations 5, 6.

Key Considerations

• The choice of antibiotic should be based on the specific infection being treated, as well as the patient's individual needs and medical history 5, 6.
• Linezolid and vancomycin have different adverse effect profiles, with linezolid being associated with a higher risk of thrombocytopenia and nausea, and vancomycin being associated with a higher risk of nephrotoxicity and ototoxicity 6, 3.
• Further studies are needed to fully understand the efficacy and safety of linezolid as an oral equivalent for vancomycin in different clinical scenarios 3.